| NPI | 1760489926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NM CNP-01548) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NM 01548) |
| Enumeration Date | 2005-07-02 |
| Last Update Date | 2023-11-07 |